Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD)

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Irritable bowel syndrome (IBS) is often referred to inaccurately as “colitis” and “mucous colitis.” But the suffix “itis” in a medical condition’s name denotes inflammation, which is not a hallmark of IBS. Rather than inflaming the colon, IBS sensitizes the nerves responsible for the contractions (called peristalsis) that propel partially digested food through the organ. As a result, the muscular inner wall overreacts to mild stimuli like milk products and emotional stress, and goes into spasm. Irritable bowel syndrome produces cramplike pains and bouts of diarrhea and/or constipation.

The more serious disorders, Crohn’s disease and ulcerative colitis, are both forms of inflammatory bowel disease. IBD damages the tissue of the small bowel and the large bowel, respectively, through the process of inflammation. As the body’s response to injury, inflammation is characterized by blood-carrying, infection-fighting white blood cells that rush to the site of the injury. Their presence accounts for the painful swelling, warmth and redness associated with an inflammatory reaction.

Among children, Crohn’s is two times more prevalent than ulcerative colitis. Whereas ulcerative colitis affects only the inner lining of the intestine and is confined to one section, “Crohn’s disease can penetrate the full thickness of the bowel and tends to occur in more than one area,” explains Dr. Alan Lake, a pediatrician and pediatric gastroenterologist at Baltimore’s Johns Hopkins University School of Medicine. In colitis, however, ulcers form where inflammation has destroyed the tissue. The open sores ooze blood, mucus and pus.

The cause of inflammatory bowel disease has yet to be discovered, although theories abound. Heredity is a factor: 15 to 30 percent of IBD sufferers have a relative with either disorder.

Symptoms that Suggest Irritable Bowel Syndrome may include:

Cramplike pain and spasms in the lower abdomen

Nausea

Bloating and gas

Headache

Rectal pain

Backache

Appetite loss

Alternating bouts of diarrhea and constipation

Fatigue

Depression

Anxiety

Difficulty concentrating

Symptoms that Suggest Inflammatory Bowel Disease may include:

Crohn’s Disease

Cramping abdominal pain and tenderness, particularly after meals

Nausea

Diarrhea

General ill feeling

Fever

Appetite loss possibly leading to weight loss

Bloody stool

Swelling, pain, stiffness in the knees and ankles

Cankerlike sores in the mouth

Eye inflammation

Irritation or swelling around the rectum

Fatigue

Depression

Anxiety

Difficulty concentrating

Delayed growth and sexual development in younger teens, due to lack of nutrition

Ulcerative Colitis

Pain and cramping in the left side of the abdomen

Intermittent episodes of bloody, mucus-like stool

Swelling, pain, stiffness in the knees and ankles

Canker-like sores in the mouth

Fatigue

Depression

Anxiety

Difficulty concentrating

Growth retardation in younger teens, due to lack of nutrition

Acute attacks may include:

Up to twenty bloody, loose bowel movements a day

Urgent need to move bowels

Severe cramps and rectal pain

Profuse sweating

Dehydration

Nausea

Appetite loss

Weight loss

Abdominal bloating

Fever up to 104 degrees F

You can see that many of the symptoms overlap, making diagnosis complicated at times. In general, says Dr. Lake, “the patient with ulcerative colitis has more bloody bowel movements, and the patient with Crohn’s disease experiences more pain.” He goes on to say that while ulcerative colitis is usually picked up quickly, “with Crohn’s disease, many months can pass between the onset of symptoms and the time of diagnosis. Not only are the symptoms subtle, but they can be minimized by cutting back on eating. So it can be difficult for parents to recognize that something is the matter.

“Frequently, kids are diagnosed because they develop inflammation elsewhere, like the eyes, the mouth and the rectum. If your child has irritation or swelling around the rectum,” he advises, “never assume that it is hemorrhoids, which is all but unheard of in children. The concern should be that he or she has Crohn’s disease.”

How Irritable Bowel Syndrome is Diagnosed:

Physical examination and thorough medical history, plus one or more of the following procedures:

Urinalysis

Urine culture

Complete blood count

Erythrocyte sedimentation rate (sed rate) blood test

Stool blood test

Sigmoidoscopy

How Inflammatory Bowel Disease is Diagnosed:

Physical examination and thorough medical history, plus one or more of the following procedures:

All of these chronic conditions are incurable but treatable, meaning that steps can be taken on several fronts to reduce the frequency and severity of symptoms.

Changes in diet: Boys and girls with IBS or IBD are able to eat relatively normally when the disease is in remission, which is much of the time. During flareups, though, they need to be conscientious about avoiding certain foods. Your pediatrician will work with a nutritionist or a GI specialist to tailor an eating plan for your youngster.In irritable bowel syndrome, adding roughage to the diet may be all that’s necessary to ease cramping and soften hardened stool or eliminate diarrhea. However, high-fiber foods induce the opposite effect in a teen with Crohn’s disease or ulcerative colitis, who should stick to easy-to-digest low-residue items like broth, gelatin, skinless poultry, fish, rice, eggs and pasta. Fried foods and dairy are also taboo when the disease is active.Memo to Mom and Dad: Help spare your son or daughter some of the unwelcome consequences of IBD by serving five or six small meals a day instead of the customary big three.

Drug therapy: If diet alone doesn’t bring relief from an irritable bowel, occasionally a pediatrician will prescribe an antispasmodic agent to slow down its activity. Medication is usually indicated in Crohn’s disease or ulcerative colitis, where the favored drugs include corticosteroids such as prednisone (“the cornerstone of treatment,” according to Dr. Lake), and the 5-ASA agents sulfasalazine, olsalazine and mesalamine. Should these fail to stem the inflammation, your pediatrician might prescribe one of the following immunomodulators: azathioprine, cyclosporine, methotrexate or 6-mercaptopurine. They work by altering the body’s immune response. An IBD patient’s medicine cabinet often contains antibiotics and antidiarrheal medicines as well.

Dietary supplements: From a child's perspective, one of the most upsetting effects of inflammatory bowel disease is its suppression of growth and sexual maturity. Large doses of prednisone can decelerate physical development; accordingly, pediatricians lower the dose or gradually take young people off the drug once it has controlled the inflammation.The main cause of poor growth, however, is insufficient nutrition. Adolescents with IBD sometimes fall into the habit of skimping on breakfast and lunch in order to avoid repeated trips to the bathroom while at school. As a result, they may be lacking in calories, nutrients, vitamins and minerals. Protein is especially crucial for growth.Your pediatrician will monitor your child’s eating patterns. Most nutritional deficiencies can be corrected by tinkering with the diet. If necessary, though, she can prescribe oral supplements and/or high-calorie liquid formulas.

Surgery: Cases of inflammatory bowel disease that resist drug therapy or develop complications may require an operation to remove part or all of the colon. This route is rarely taken during the teen years.

Mental health care: Emotional stress does not cause IBS or IBD, but it can aggravate either condition. Therefore, patients may benefit a great deal from seeing a mental health professional who can teach them stress-reduction techniques such as progressive muscle relaxation and progressive guided imagery. As with other chronic ailments, inflammatory bowel disease can be frustrating for teenagers. Flareups often leave them more dependent on their parents than they want to be and make them feel different from their friends. They may feel as though their body has betrayed them. If you suspect that your son or daughter is having a hard time coping, ask your pediatrician for a referral to a suitable counselor.

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.